other investigations to consider in general practice, before referral, if hepatitis C antibody positive

Last reviewed 01/2018

The following investigations can be offered in primary care to all positive patients before referring them. Practitioner's preference may cause these tests to be carried out in specialist centres.

• HCV RNA to test for active infection in the blood
• full blood count (FBC) including differential to check for anaemia, neutropenia etc, low platelets and signs of high alcohol consumption etc
• urea and electrolytes (U+E), creatinine and calcium
• liver function tests (LFT) - such as alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) (these indices are not good indicators of liver damage or the severity of the HCV infection)
• glucose
• thyroid function tests (TFT) - since treatment with interferon may lead to thyroid dysfunction (hyper or hypo thyroidism)
• ferritin - to check if the iron stores are elevated in patients with CHC
• investigations for hepatitis B infection
  • hepatitis B surface antigen (HBsAg, also known as Australian Antigen, which signifies presence of HBV);
  • hepatitis B core antibody (HBcAb or Anti-HBc, which indicates acute or chronic infection)
  • hepatitis B surface antibody (HBsAb or Anti-HBs which indicates antibodies to the surface and if positive means that the person is immune to hepatitis B (from either having had the disease or from having been given the vaccine); and
  • antibodies to 'e' (Anti-HBe) which indicates low infection rate and probable recovery
• hepatitis A, if not done previously as any other form of hepatitis can be detrimental to hepatitis C
• HIV antibody test, even if they previously tested negative as HIV is currently increasing in injecting drug users (1)

Reference:

• 1. Royal College of General Practitioners (RCGP) 2007.Guidance for the prevention, testing, treatment and management of hepatitis C in primary care ongoing management in primary care